The U.S. vs. Europe as an emerging pharma commercial leader: A Q&A with Nancy Hunter

Key takeaways:

• Early and rigorous commercial planning is non-negotiable in drug development. Emerging pharma companies in Europe can be slow to integrate market factors from the outset, so be ready to challenge conventional thinking.
• European and U.S. markets have fundamentally different business cultures. European sources of capital can be more risk-averse, requiring a more rigorous approach to defining the commercial opportunity.
• Achieving regulatory approval is an important milestone, but market access and reimbursement are the primary drivers of patient access and ultimate commercial viability.

After 15 years progressively advancing in U.S.-focused roles at companies like Eli Lilly and Amgen, Nancy Hunter transitioned to a European commercial leadership position in Switzerland. Since then, she has served as the head of commercial at two emerging pharmaceutical companies in Europe. She sat down with ZS Principal Adam D’Luzansky to discuss the fundamental differences in the commercial function between the U.S. and Europe.

Adam D’Luzansky: You worked in diverse commercial roles at Eli Lilly and Amgen in the U.S. What motivated you to take on a European role at Amgen?

Nancy Hunter: What motivated me? I fell in love with having a proper cup of coffee. On a serious note, I appreciated the challenge of understanding a system and a way of life that differed from the one I grew up in—both from a professional and personal perspective.

From a colleague perspective, I enjoyed working as part of a multicultural team. The diverse viewpoints and life experiences enriched our problem-solving process. Often, the teams arrived at solutions differently than I initially expected, and these solutions were effective within the social context of that company and country at that particular time.

On the commercial preparation front, understanding the payer system in Europe and gaining firsthand knowledge of each country’s different requirements was both fascinating and challenging compared to the U.S. system. Evolution is constantly occurring in the reimbursement processes and procedures of each country, and I was eager to stay current on these shifts to make informed commercial decisions.

AD: What kept you in Europe after that first experience?

NH: I always had the desire to live and work internationally, but I stayed in Europe because I continued to feel like there was so much to learn. I’m an inquisitive person—learning is like fuel. The more knowledge and experiences I acquired, the greater my desire to explore. Once I began learning more about the complexities of each country, it became even more interesting. On the personal front, working and living in an expat community is highly enriching. From conversations to friendships and new perspectives, it is a fulfilling way to live. Coming from a small town in Northeastern Montana, I’ve often felt immense gratitude for the opportunities and experiences I’ve had throughout my career. Expats tend to be a unique group in that they are often curious, open-minded and great problem solvers because they need to flex their “adaptability” muscle often.

AD: How did your U.S. experience prepare or limit you as you adapted to leading in Europe?

NH: Starting in the U.S. was beneficial because most companies, regardless of their geographic location, still prefer to launch in the U.S. first (although that may be changing given the current administration). For example, thoroughly mapping out how a company can best serve patients and physicians while optimizing the launch timing, collaborating with a cross-functional team to ensure the product label is the strongest possible, understanding the impact of public policy teams and working with C-suite teams to clarify pricing and various routes to revenue—all of this is invaluable learning.

When I first moved to Europe, I needed to adapt my style of leadership and problem solving. For example, one of the first lessons I learned was how to “dial down” my U.S. positivity. A dear European colleague pulled me aside to provide that feedback during my first full-time role in Switzerland. It is maybe a more Germanic business approach, but if something is working well, it’s not overly discussed at a meeting. The energy of a meeting is instead focused on solving a problem, which is seen as time well spent, versus discussing something that is already working well.  

U.S. leaders are often known for using too many American-centric analogies that don’t make sense in an international team context. Additionally, I’ve heard many European colleagues describe the U.S. approach to strategy setting as “shoot first and then aim” meaning, they would be well served to spend more time solidifying a solid strategic approach before implementing a solution. In the U.S., failing fast and trying again can be seen as a badge of honor and doesn’t necessarily inhibit additional investment or have an immediate downside. Being aware of my own cultural biases and actively catching myself using U.S.-focused idioms during a meeting or moving too quickly toward solution mode was a good exercise in adapting the way I expressed myself in a team environment.

AD: So you first came to Europe with a large, global company, but then you transitioned into emerging pharma and have been in these smaller companies ever since. What prompted the move to emerging pharma?

NH: Big pharma is a great place to learn and understand the fundamentals. I was taught by some of the best. However, at my core, I’m an explorer and I like the learning process—I’m interested in understanding different ways of doing things. Ultimately, it was that mindset that drew me to smaller companies. I’ve found so much joy recently setting up a new company, exploring higher-level leadership roles, and pitching directly to investors both in Europe and the U.S. One of the best aspects of having more tenure is that I often have the opportunity to work with many dear friends I’ve made over the years in our industry. I’m having such a good time reconnecting; it’s a different kind of feeling now versus early on in my career, and I’m loving it.

AD: How is emerging pharma commercialization different in Europe versus the U.S.?

NH: There are several differences. Typically, in Europe, launch timelines are extended due to requests for reimbursement at the member-state level; there’s less internal headcount allocated to do the work, and the amount of money spent on commercialization varies per country given extenuating factors such as time to market, etc. In the U.S., a pharma company can often scale rather quickly—it’s largely one market with one language but with a heavy volume of hospitals, HCPs, patients and payers to consider. It’s important to recognize that each state has distinct guidelines for government healthcare programs, such as Medicaid. That’s where the perceived efficiency of one market shifts a bit, due to payer negotiations and state-by-state guidelines and timelines.

In Europe, notice periods for employees are longer than in the U.S. (often 3-6 months depending on title, level of employee) and therefore, scaling a team takes time. However, there is often more protection for employees in Europe via country-level work councils and employment protection acts and that is a nice change versus the U.S. model.

Funding for emerging pharma or biotech in Europe is often distinct from the U.S. as well. From my perspective, European investors tend to be more cautious overall as they prioritize capital preservation and desire proof of traction. EU VCs manage smaller fund sizes typically and can be more conservative on their deal size and risk appetite. As a person who came out of a U.S. business school atmosphere, the shift from charismatic storytelling and asking for bigger dollar sums was a learning curve as European investors often valued a more conservative approach when raising funds.

One other critical point to mention is, in my opinion, many emerging European pharma companies start thinking about commercialization too late during their go-to-market process, especially if they want to launch in the U.S. first. Perhaps this later planning is culturally tied to cautious investing. The rigor required for optimal market access and reimbursement is high in 2025, and emerging companies are holding onto assets longer in development and considering commercialization much later, which puts them in a difficult position.

Typically, earlier-stage R&D companies don’t yet fully understand the power of proper new product planning and how specific trial endpoints, label language and similar factors need to be considered much earlier in the development process to create a robust, promotable label; this is true whether they are commercializing their own asset or trying to secure a business development deal with another company who will commercialize. Moving from the R to D to C is not an easy transformation for any emerging pharma company, regardless of country.

AD: By necessity, emerging pharma companies need to be lean and efficient with their resources. When fighting for commercial investments, how do you think about prioritization?

NH: I’ve often said I would allocate more funds into robust new product planning for emerging pharma companies, especially those with assets in early phase 2. I’d also put more effort into developing a clear understanding of the market access and reimbursement pathways required, including early discussions on RWE [real-world evidence] and pricing.

Often, startups don’t know what they don’t know, and they end up paying the price later on, such as being forced to accept less valuation in a deal than they could have commanded if they’d had an optimized TPP [target product profile]. It can be frustrating to watch this play out as a commercial person. I would love to sit with investor teams and coach them on pertinent questions to ask an emerging biotech company seeking to raise funds. For example, if a company lacks a clear, well-articulated, fact-based understanding of how its drug will be added to the formulary and potentially reimbursed in any market, that’s a red flag, in my opinion.

FDA or EMA approval is just one step in the process. The ultimate goal is to get a drug properly placed on the formulary and secure appropriate reimbursement, allowing patients to have access. That is why we are here—to provide patients and their physicians with options along their treatment pathway.

AD: We see a lot of emerging pharma companies led by CEOs who come from banking or scientific careers, and they don’t easily understand commercialization, especially the investments required for commercial success. What have you learned about how to coach these executives on the importance of commercial investments?

NH: For non-U.S. CEOs coming from a banking or research-only background (meaning they may be well versed in raising funds, but not yet generating pharma revenue), learning about the realities and complexities of the U.S. healthcare system is eye-opening, especially if they want to penetrate that market with multiple product follow-ups. In these instances, I’ve brought U.S. market access experts to Europe to lead workshops on the realities of U.S. healthcare. That’s been a win for the commercial team—spending more time educating the C-Suite and functional partners upfront leads to more informed decision-makers. I’d say the same is true in reverse. For U.S. CEOs from banking or research, viscerally understanding how various key countries in Europe operate during the commercialization process is also invaluable learning. I used to say to my U.S. colleagues, tongue-in-cheek, “This is not the United States of Europe,” as they were learning about the various nuances to commercialization per country.

In my 20-plus years in the business, I’ve yet to see a drug market itself based on science alone. Acceptance by government or commercial payers, hospital formulary committee members and treating physicians all takes time, effort and appropriate clinical data for discussion—educating CEOs new to the commercialization process just makes sense.

For example, for noncommercial CEOs, it’s helpful to have general knowledge of what a preapproval information exchange deck is and how it’s used or to understand what implications must be considered in a pricing committee decision. Additionally, having a rough idea of how long a hospital P&T committee process takes until the final decision on whether or not your company’s new drug is added to hospital formulary is a step in the right direction. All of these processes impact commercial timelines, which in turn affect product uptake and time to revenue.

It is important to note that sometimes the issue surrounding commercialization is a funding-related concern. CEOs often face complex tradeoffs and therefore don’t want to spend on commercialization too early. However, my experience has been that if the CEO understands the commercialization process and timing and values both, those leaders want to be solution-oriented and often push to fund appropriately for the sake of the patient and an optimized launch uptake. Effective launches don’t have to have all the bells and whistles of a typical big pharma launch, but they do need to be targeted to the right patient, facility and physician group at the right time.

AD: What advice would you give someone interested in making the move from U.S. to European pharma?

NH: I’d encourage them to understand what their personal motivations are for making the move—what’s drawing them toward this particular change. Is it an opportunity to grow or a way to temporarily retreat from the discomfort of a current situation? I’d invite them to map out what they can offer a company, how that knowledge or skill set might be helpful in another country and then test that theory with actual colleagues from that country.

I also encourage aspiring expats to really understand their personality. Do they adapt well to things outside the norm? Do they honestly appreciate different cultures or different ways of thinking that may not make sense in their current cultural framework? Can they ask for help readily? Often, it’s humbling and frustrating not to know how things work in any given country. Are they good at putting themselves out there to make new friends? Being adaptable and accepting of “things not working like they do in your home country” is crucial if you want to be successful.

Other questions I would ask are: How comfortable are you living as an “outsider”? For example, working and living on the “outside” can be lonely and frustrating. Signing a lease in a foreign country in their native language or negotiating a contract where the legal system doesn’t work like the U.S. are all experiences I’ve had that just add another layer of complexity to life in general. Additionally, not having a ready-made group of friends to hang out with on the weekends or go on local excursions with can also be daunting. Therefore, being good at making new friends or creating opportunities to hang out with people is also key.

There are often lots of lonely days as an expat, and you will need to have the strength of character to surf that wave. I recommend reaching out to former and current expats you may know and ask them the tough questions, one-on-one. Most people will be happy to share their trials and their breakthroughs, too. I’ve found it to be a very rewarding way to live, but it does come at a personal cost.

AD: What does leadership mean to you as you build teams and develop future leaders?

NH: There are many facets to leadership, but for our discussion today, good leadership in a cross-cultural environment means being humble enough to listen and learn from the people around you, being authentic and adapting your thinking and behaviors if necessary. I’m really inspired by the younger generation coming up; many have well-developed soft skills and a focus on social responsibility and inclusion, which will likely lead to better teamwork and openness, perfect for cross-cultural living and leadership. As a leader, I try to be conscious of the environment I create; often, the best thing I can do is bring the right people together in the room and then get out of their way, enabling talent to push forward and create solutions without micromanaging.

As for developing future leaders, I believe in exposing people early to where they may be headed in their careers, whether it’s investor conversations, press interactions or other opportunities. It’s better to learn these skills or at least be exposed to the process before you absolutely need to implement them. I wish someone had invited me into those conversations earlier in my career, and that’s what I strive to do for the next generation of leaders.

This is the third of our interview series, where we talk about the CCO function in emerging biopharma. See the second interview here.